Half of all people with diabetes don't even know they have it
En Perú, una de las crisis de salud pública más persistentes no radica en la ausencia de conocimiento médico, sino en la incapacidad del sistema para acompañar al paciente a lo largo del tiempo. La llamada 'Regla de las Mitades' revela cómo, en cada etapa del camino —diagnóstico, acceso, tratamiento, control— la mitad de los pacientes con diabetes tipo 2 se pierde, hasta que solo seis de cada cien logran vivir sin complicaciones graves. Es una fractura estructural que convierte lo prevenible en inevitable, y que plantea una pregunta moral tan urgente como técnica: ¿cuánto vale la continuidad del cuidado?
- Solo el 6% de los pacientes con diabetes tipo 2 en Perú logra controlar la enfermedad sin desarrollar complicaciones severas como insuficiencia renal, infartos o amputaciones.
- El sistema pierde pacientes en cada eslabón: la mitad no sabe que tiene diabetes, y de quienes sí lo saben, muchos abandonan el seguimiento médico antes de alcanzar sus metas terapéuticas.
- La fragmentación no es un accidente clínico sino una falla sistémica: falta de detección temprana, barreras de acceso a medicamentos modernos y ausencia de monitoreo continuo se combinan para hacer inevitable el daño.
- Una nueva generación de terapias basadas en análogos de GLP-1 —reconocidas ya por la OMS como medicamentos esenciales— ofrece la posibilidad de controlar simultáneamente la glucosa, el peso y el riesgo cardiovascular.
- Especialistas exigen programas de detección más tempranos, mayor acceso a tratamientos actualizados y un modelo de atención que no abandone al paciente tras el diagnóstico inicial.
La diabetes tipo 2 es una de las crisis sanitarias más persistentes del Perú, no por falta de conocimiento médico, sino por la incapacidad del sistema de salud para sostener a los pacientes a lo largo del tiempo. Un modelo de análisis llamado la 'Regla de las Mitades', desarrollado por la iniciativa global Cities for Better Health de Novo Nordisk y validado en más de cincuenta ciudades del mundo, lo ilustra con una aritmética implacable: de todos los peruanos con diabetes tipo 2, la mitad no sabe que la tiene; de quienes sí lo saben, solo la mitad recibe atención médica; de los que reciben atención, solo la mitad alcanza sus metas de tratamiento; y de ese grupo, solo la mitad evita complicaciones graves. El resultado: apenas seis o siete de cada cien pacientes logran controlar la enfermedad sin que esta destruya sus riñones, su corazón o su visión.
El doctor Roger Uzcátegui, director médico de Novo Nordisk para América Latina, señala que el verdadero desafío no es solo detectar la enfermedad, sino acompañar al paciente desde el diagnóstico hasta el control sostenido, dotándolo de herramientas modernas que prevengan el daño antes de que ocurra. En ese contexto, los nuevos fármacos basados en análogos de GLP-1 representan un avance significativo: además de regular la glucosa, reducen el peso corporal y protegen el corazón y los riñones. Su reciente inclusión en la Lista de Medicamentos Esenciales de la OMS subraya su relevancia clínica.
Sin embargo, el acceso a estas terapias sigue siendo limitado, y el Atlas de Diabetes 2025 de la Federación Internacional de Diabetes documenta un aumento sostenido de casos impulsado por el sedentarismo, la obesidad y la escasez de especialistas. Los endocrinólogos peruanos insisten en la necesidad de programas de detección temprana, mejor acceso a medicamentos modernos y un seguimiento continuo que incluya educación en salud. Millones de peruanos enfrentan complicaciones que podrían evitarse. El sistema sabe lo que hay que hacer. La pregunta es si el país está dispuesto a invertir en que ocurra.
Type 2 diabetes remains one of Peru's most stubborn public health crises. The country has modern medicine, advanced technology, and clinical expertise—yet the vast majority of diabetic patients never receive the sustained, comprehensive care that would prevent the disease from destroying their bodies. By one measure, only six or seven out of every hundred people living with type 2 diabetes in Peru manage to keep it under control without developing serious complications.
That measure is called the Rule of Halves, a diagnostic framework developed by Novo Nordisk's global Cities for Better Health initiative and tested across more than fifty cities worldwide. It works like this: start with all people who have type 2 diabetes. Half of them don't know they have it. Of the half that do know, only half actually receive medical care. Of those receiving care, only half meet their treatment targets. And of that final group, only half avoid developing complications—kidney disease, heart attacks, blindness, amputations. The math is brutal. Each stage cuts the population in half. What remains is a small minority of patients who get what they need, when they need it, and for as long as they need it.
The fragmentation this reveals is structural, not accidental. Dr. Roger Uzcátegui, senior medical director for cardiometabolic care at Novo Nordisk's Latin American division, described it plainly: half of all people with diabetes don't know they have it, and many of those who do get diagnosed abandon their follow-up care. The real challenge isn't just finding people with the disease—it's staying with them from beginning to end, equipping them with modern tools to live better and prevent damage before it happens.
Recent advances in treatment are beginning to shift the landscape. A new class of drugs based on GLP-1 analogs has entered the conversation. These medications do more than regulate blood sugar. They also influence body weight and reduce certain cardiovascular and kidney risks. The World Health Organization recently added them to its List of Essential Medicines, a recognition of their clinical significance. Dr. Ileana Chiari, medical director of Novo Nordisk's Latin American operations, explained that these therapies allow doctors to address multiple problems at once: controlling glucose, reducing weight, and protecting vital organs. They don't replace other necessary interventions, but they do improve how well patients stick with treatment and what results they actually achieve.
The International Diabetes Federation's 2025 Diabetes Atlas documents a relentless rise in cases. Sedentary lifestyles, obesity, and the scarcity of specialist access all conspire to make proper disease management nearly impossible for most people. Endocrinologists warn that the absence of regular checkups dramatically increases the risk of kidney failure, heart attacks, vision loss, and amputation. They're calling for earlier detection programs, better access to modern medications when clinically appropriate, and sustained follow-up that includes health education and continuous monitoring.
The stakes are not abstract. Millions of Peruvians with diabetes face preventable suffering. The system knows what needs to happen. The question now is whether the country will invest in making it happen.
Citações Notáveis
The Rule of Halves is a mirror of our reality. The challenge isn't just detecting the disease—it's accompanying the patient from beginning to end with modern tools that allow them to live better and prevent complications.— Dr. Roger Uzcátegui, Senior Medical Director, Novo Nordisk CLAT
With GLP-1 treatments we can act on multiple dimensions at once: control glucose, reduce weight, and protect vital organs like the heart and kidneys.— Dr. Ileana Chiari, Medical Director, Novo Nordisk CLAT
A Conversa do Hearth Outra perspectiva sobre a história
Why does the Rule of Halves matter so much? It's just a model.
Because it shows where the system actually breaks. It's not one big failure—it's five smaller ones stacked on top of each other. You can't fix what you can't see.
So half of people don't even know they're diabetic?
Right. And that's often the easiest half to find. The harder part is the people who know, get treatment, but then stop showing up. Life gets in the way. The medication is expensive or has side effects. They feel fine, so why keep taking it?
What changes with these new GLP-1 drugs?
They work on multiple fronts at once. You're not just lowering blood sugar—you're also losing weight, protecting your heart and kidneys. When a patient sees those kinds of results, they're more likely to stay with the treatment.
But these drugs are expensive, aren't they?
Very. That's the real barrier. The innovation exists. The problem is access. A drug that works brilliantly doesn't help anyone who can't afford it.
What would actually fix this in Peru?
You'd need three things working together: better screening in primary care so people get diagnosed early, affordable access to modern medications, and a system that doesn't let patients disappear after their first visit. It's not complicated. It's just expensive and requires sustained commitment.